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Nurse Visits Help Babies

School of Medicine

7/8/2014

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Low-income mothers and their first-born children who
received home visits from nurses were less likely to die from preventable
causes during a two-decade period studied by a University of Colorado School of
Medicine professor, according to a report published in JAMA Pediatrics –
a leading, peer-reviewed journal of the American Medical Association.

David Olds, PhD, professor of pediatrics and lead
investigator of the study, reviewed data covering a two-decade period to
understand the impact of the Nurse-Family Partnership® (NFP) program and found
that low-income mothers and their first-born children living in disadvantaged,
urban neighborhoods were less likely to die when they received in-home nurse
visits when compared to mothers and children randomly assigned to receive
comparison services. This is the first randomized, clinical trial of an early
intervention program conducted in a high-income country to find evidence of
reductions in maternal and child death.

“Death
among mothers and children in these age ranges in the United States general
population is rare, but of enormous consequence,” said Olds. “The high rates of
death among mothers and children not receiving nurse-home visits reflect the
toxic conditions faced by too many low-income parents and children in our
society. The lower mortality rate found among nurse-visited mothers and
children likely reflects the nurses’ support of mothers’ basic human drives to
protect their children and themselves.”

Beginning
in 1990, this trial enrolled low-income, primarily African-American mothers
living in disadvantaged neighborhoods in Memphis, Tenn., and assessed maternal
and child mortality for over two decades until 2011. Olds announced today these
findings at a press conference held at Le Bonheur Children’s Hospital, which
serves families through NFP in Memphis.

Nurse-Family
Partnership produced a significant reduction in preventable child death from
birth until age 20. Children in the control group not receiving nurse-home
visits had a mortality rate of 1.6 percent for preventable causes – including
sudden infant death syndrome, unintentional injuries and homicide. There were
zero preventable deaths among nurse-visited children.

In
addition, over the same two-decade period, mothers who received nurse-home
visits had significantly lower rates of death for all causes compared to
mothers not receiving nurse-home visits. Mothers in the control group who did
not receive nurse-home visits were nearly three times more likely to die than
were nurse-visited mothers. The reduction in maternal mortality was even
greater for deaths due to external causes – those tied to maternal behaviors
and environmental conditions – including unintentional injuries, suicide, drug
overdose and homicide. Mothers not receiving nurse-home visits were eight times
more likely to die of these causes than nurse-visited mothers.

“We
intend to continue this research to see whether Nurse-Family Partnership
reduces premature mortality at later ages and corresponding health problems as
the mothers and children grow older,” said Olds.

Earlier
follow-up studies of the Memphis trial found that nurse-visited mothers,
compared to those assigned to the control group, had better prenatal health and
behavior; reduced rates of closely-spaced subsequent pregnancies; decreased use
of welfare, Medicaid and food stamps; fewer behavioral impairments due to
substance use; and fewer parenting attitudes that predispose them to abuse
their children. At earlier phases of follow-up, nurse-visited children, compared
to children not receiving nurse-home visits, were less likely to be
hospitalized with injuries through age 2; less likely to have behavioral
problems at school entry; and less likely to reveal depression, anxiety and
substance use at age 12.

The
Nurse-Family Partnership program is a national home visiting program for
low-income women who are having their first babies. Each woman is paired with a
registered nurse who provides her with home visits throughout her pregnancy
until her child’s second birthday. The program’s main goals are to improve
pregnancy outcomes, children’s health and development and women’s personal
health and economic self-sufficiency.

This
follow-up study of the Memphis trial is the most recent report from a series of
randomized, clinical trials of the NFP program conducted over
the past 37 years. Families in these trials are being followed over their
life-course to estimate NFP’s long-term effects. The Coalition for
Evidence-Based Policy – a nonprofit, nonpartisan organization – has identified
Nurse-Family Partnership as the only prenatal or early childhood program that
meets its “Top Tier” evidence standard, which is used by
the U.S. Congress and the executive branch to distinguish research-proven
programs.

About Nurse-Family Partnership

The
Nurse-Family Partnership National Service Office (www.nursefamilypartnership.org) is committed
to producing enduring improvements in the health and well-being of low-income,
first-time parents and their children by helping communities implement and
sustain an evidence-based
public health program
of home visiting by registered nurses. Nurse-Family Partnership is the most
rigorously tested maternal and
early childhood health program of its kind. Randomized, controlled
trials conducted over 37 years demonstrate multi-generational outcomes that
benefit society economically and reduce long-term social service expenditures.
Nurse-Family Partnership is headquartered in Denver.

In
the United States, Nurse-Family Partnership currently serves over 29,000 women
in 43 states, the U.S. Virgin Islands and six tribal communities through the
NFP National Service Office. In addition, NFP is implemented in six additional
countries through the Prevention
Research Center for Family and Child Health at the
University of Colorado, directed by NFP founder David Olds.